Mascarell Paula, Gutiérrez-Ortiz de la Tabla Ana, Ledesma Christian, Fernández-González Marta, Padilla Sergio, García-Abellán Javier, Botella Ángela, Telenti Guillermo, Bello-Perez Melissa, Gutiérrez Félix, Masiá Mar
Infectious Diseases Unit, Hospital General Universitario de Elche, Spain.
Universidad Miguel Hernández de Elche, Spain.
AIDS. 2025 Aug 8. doi: 10.1097/QAD.0000000000004313.
High-resolution anoscopy (HRA) is crucial for detecting and managing high-grade squamous intraepithelial lesions (HSIL), the main precursor to anal cancer. However, program success is often hindered by long-term retention, which in some studies reaches only 50%. Patient acceptability, a major factor in adherence, is often overlooked.
To evaluate the long-term feasibility, safety, acceptability, and retention of an anal cancer screening program in an HIV clinic that prioritizes patient-centered strategies.
This single-center, longitudinal cohort study was conducted at a public HIV and Sexual Health Clinic in Spain. Eligible participants included MSM with HIV aged ≥30 years and abnormal cytology, or individuals with prior anal cancer or HPV-related anogenital dysplasia. Retention was defined as the proportion who remained enrolled or completed protocol. Acceptability, appropriateness, and feasibility were assessed using a validated 4-item survey. Safety was measured through adverse event monitoring. The internal consistency of the 4-item survey was assessed using Cronbach's alpha.
Of 389 screened participants, 21.3% were diagnosed with HSIL and 49.4% experienced recurrence. One early-stage anal cancer was detected. Adverse events were mild and self-limited. Retention at 10 years was 88.9%, with a median follow-up duration of 54.5 months (interquartile range, 21.7-116.5). Patient satisfaction was high: 96.5% rated the program as acceptable, 97.5% as appropriate, and as 96.5% feasible, though procedural ease scored slightly lower.
High long-term retention and strong acceptability suggest that patient-focused approaches may enhance engagement in care and warrant consideration in the design of similar programs in HIV clinics.
高分辨率肛门镜检查（HRA）对于检测和管理高级别鳞状上皮内病变（HSIL）至关重要，而HSIL是肛门癌的主要前驱病变。然而，该项目的成功往往受到长期留存率的阻碍，在一些研究中，留存率仅达到50%。患者的可接受性是依从性的一个主要因素，但常常被忽视。
评估在一家以患者为中心策略为优先的艾滋病诊所中，肛门癌筛查项目的长期可行性、安全性、可接受性和留存率。
这项单中心纵向队列研究在西班牙一家公共艾滋病和性健康诊所进行。符合条件的参与者包括年龄≥30岁、细胞学异常的感染艾滋病毒的男男性行为者（MSM），或既往有肛门癌或HPV相关肛门生殖器发育异常的个体。留存率定义为继续参与或完成方案的比例。使用经过验证的4项调查问卷评估可接受性、适宜性和可行性。通过不良事件监测来衡量安全性。使用克朗巴赫α系数评估4项调查问卷的内部一致性。
在389名接受筛查的参与者中，21.3%被诊断为HSIL，49.4%经历复发。检测到1例早期肛门癌。不良事件轻微且为自限性。10年时的留存率为88.9%，中位随访时间为54.5个月（四分位间距为21.7 - 116.5）。患者满意度较高：96.5%的人认为该项目可接受，97.5%认为适宜，96.5%认为可行，不过操作便利性得分略低。
高长期留存率和高可接受性表明，以患者为中心的方法可能会增强对医疗护理的参与度，值得在艾滋病诊所设计类似项目时予以考虑。
